Vermont H 680: An act relating to the workers’ compensation rate of contribution

Bill Text

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VT LEG #386171 v.1
H.680 1
Introduced by Representatives Olson of Starksboro, Cole of Hartford, 2
Garofano of Essex, Greer of Bennington, Keyser of Rutland 3
City, Labor of Morgan, Masland of Thetford, McCann of 4
Montpelier, and Yacovone of Morristown 5
Referred to Committee on 6
Date: 7
Subject: Health; health care professionals; primary care; Agency of Human 8
Services; Green Mountain Care Board 9
Statement of purpose of bill as introduced: This bill proposes to establish a 10
primary care access reform program in which participating primary care 11
providers would receive a monthly payment from the patient’s health insurer or 12
other payer for each participating patient that would cover the patient’s routine 13
primary care services for the month without any cost-sharing requirements. 14
The bill would require reports from the Agency of Human Services on 15
expanding the program and from the Green Mountain Care Board on site-16
neutral reimbursements. The bill would also invest funds in primary care 17
workforce development programs for fiscal year 2027 and eliminate the 2027 18
sunset on a primary care physician scholarship program. 19
An act relating to a primary care access reform program 20

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VT LEG #386171 v.1
It is hereby enacted by the General Assembly of the State of Vermont: 1
Sec. 1. FINDINGS; LEGISLATIVE INTENT 2
(a) The General Assembly finds that: 3
(1) Good access to primary care is essential for the health of Vermonters 4
and for reducing the need for more costly services, but Vermont’s health care 5
system currently does not provide access to primary care with the timeliness 6
and scope that Vermonters need. This lack of access pushes patients to seek 7
traditional primary care services from specialists, urgent care clinics, 8
emergency departments, pharmacies, out-of-state telehealth platforms, and 9
other sources, further fragmenting care, reducing the professional satisfaction 10
of primary care clinicians, and undermining patient trust in the primary care 11
medical system. 12
(2) Primary care clinicians and patients face significant system-imposed 13
administrative and cost burdens that delay or restrict provision of and access to 14
high-value primary care. In addition, primary care clinicians are not 15
compensated commensurate with their value to the health care system. As a 16
result, many primary care clinicians are leaving their Vermont practices, and 17
too few new clinicians are replacing them. Other clinicians are choosing a 18
concierge or direct-care practice model in an effort to restore the focus on the 19
patient-provider relationship and to avoid some of the cumbersome barriers in 20
the health care system. While these models offer significant benefits to both 21

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VT LEG #386171 v.1
patients and providers, the patient panel sizes are generally much smaller than 1
in traditional practice models, so more such practices are needed to meet the 2
State’s overall primary care needs. 3
(3) Vermont’s health care system is in a state of crisis. Premiums in the 4
commercial health insurance markets are increasingly out of reach for 5
individual Vermonters, their families, private employers, and public employers 6
such as schools and State and local governments. Increasing support for our 7
primary care system in service of improving access to primary and preventive 8
services is Vermont’s best opportunity for short- and long-term improvements 9
to Vermont’s health care system and to the health of Vermonters. 10
(4) Access reform for primary care must support the four key functions 11
of primary care—first-contact access, comprehensiveness, coordination, and 12
continuity—which are essential to meeting the goals of improved quality and 13
reduced spending. The success of access reform is highly dependent on 14
alignment across payers and is unlikely to work if only a small subset of a 15
practice’s patient population is included. Increased investment in primary care 16
across public and private payers using value-based care models designed for 17
primary care will contribute significantly to improving health, reducing 18
inequities, reducing the per capita cost of care over time, and improving the 19
well-being of the primary care team. 20

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VT LEG #386171 v.1
(5) A national time study revealed that during the office day, physicians 1
spent 27.0 percent of their total time on direct clinical face time with patients 2
and 49.2 percent of their time on electronic health records and desk work. A 3
2022 study found that primary care clinicians would need to work 26.7 hours 4
per day to provide guideline-recommended primary care to the typical patient 5
panel, including documentation and message management. 6
(6) In 2020, the Green Mountain Care Board and the Department of 7
Vermont Health Access submitted a rep